Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
JAMA Psychiatry. 2023 Oct 1;80(10):1047-1054. doi: 10.1001/jamapsychiatry.2023.2225.
Individuals presenting with first-episode psychosis (FEP) may have a secondary ("organic") etiology to their symptoms that can be identified using neuroimaging. Because failure to detect such cases at an early stage can have serious clinical consequences, it has been suggested that brain magnetic resonance imaging (MRI) should be mandatory for all patients presenting with FEP. However, this remains a controversial issue, partly because the prevalence of clinically relevant MRI abnormalities in this group is unclear.
To derive a meta-analytic estimate of the prevalence of clinically relevant neuroradiological abnormalities in FEP.
Electronic databases Ovid, MEDLINE, PubMed, Embase, PsychINFO, and Global Health were searched up to July 2021. References and citations of included articles and review articles were also searched.
Magnetic resonance imaging studies of patients with FEP were included if they reported the frequency of intracranial radiological abnormalities.
Independent extraction was undertaken by 3 researchers and a random-effects meta-analysis of pooled proportions was calculated. Moderators were tested using subgroup and meta-regression analyses. Heterogeneity was evaluated using the I2 index. The robustness of results was evaluated using sensitivity analyses. Publication bias was assessed using funnel plots and Egger tests.
Proportion of patients with a clinically relevant radiological abnormality (defined as a change in clinical management or diagnosis); number of patients needed to scan to detect 1 such abnormality (number needed to assess [NNA]).
Twelve independent studies (13 samples) comprising 1613 patients with FEP were included. Of these patients, 26.4% (95% CI, 16.3%-37.9%; NNA of 4) had an intracranial radiological abnormality, and 5.9% (95% CI, 3.2%-9.0%) had a clinically relevant abnormality, yielding an NNA of 18. There were high degrees of heterogeneity among the studies for these outcomes, 95% to 73%, respectively. The most common type of clinically relevant finding was white matter abnormalities, with a prevalence of 0.9% (95% CI, 0%-2.8%), followed by cysts, with a prevalence of 0.5% (95% CI, 0%-1.4%).
This systematic review and meta-analysis found that 5.9% of patients presenting with a first episode of psychosis had a clinically relevant finding on MRI. Because the consequences of not detecting these abnormalities can be serious, these findings support the use of MRI as part of the initial clinical assessment of all patients with FEP.
出现首发精神病（FEP）的个体可能存在其症状的继发性（“器质性”）病因，可通过神经影像学来识别。因为未能在早期发现此类病例会产生严重的临床后果，所以有人建议对所有出现 FEP 的患者都应强制进行脑部磁共振成像（MRI）检查。然而，这仍然是一个有争议的问题，部分原因是该人群中临床上相关的 MRI 异常的患病率尚不清楚。
得出首发精神病患者中临床相关神经影像学异常患病率的荟萃分析估计值。
截至 2021 年 7 月，检索了 Ovid、MEDLINE、PubMed、Embase、PsychINFO 和 Global Health 等电子数据库。还检索了纳入文章和综述文章的参考文献和引文。
如果报告颅内放射影像学异常的频率，则纳入 FEP 患者的 MRI 研究。
由 3 名研究人员独立进行提取，并计算了汇总比例的随机效应荟萃分析。使用亚组和荟萃回归分析测试了调节因素。使用 I2 指数评估异质性。使用敏感性分析评估结果的稳健性。使用漏斗图和 Egger 检验评估发表偏倚。
具有临床相关影像学异常的患者比例（定义为改变临床管理或诊断）；需要扫描的患者数量以发现 1 个此类异常（需要评估的数量[NNA]）。
纳入了 12 项独立研究（13 个样本），共纳入 1613 例首发精神病患者。这些患者中，26.4%（95%CI，16.3%-37.9%；NNA 为 4）存在颅内放射影像学异常，5.9%（95%CI，3.2%-9.0%）存在临床相关异常，NNA 为 18。这些研究结果的异质性程度很高，分别为 95%至 73%。最常见的临床相关发现类型是白质异常，其患病率为 0.9%（95%CI，0%-2.8%），其次是囊肿，其患病率为 0.5%（95%CI，0%-1.4%）。
本系统评价和荟萃分析发现，5.9%的首发精神病患者在 MRI 上有临床相关发现。由于未能检测到这些异常的后果可能很严重，因此这些发现支持将 MRI 作为所有首发精神病患者初始临床评估的一部分。
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